COVID-19 lockdown impact on quality of treatment and outcomes of STEMI and stroke patients in a large tertiary medical center: An observational study

Alex Galper, Racheli Magnezi*, Anat Ekka Zohar, Bernice Oberman, Eyal Zimlichman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The coronavirus 2019 (COVID-19) pandemic affected health-care systems worldwide, leading to fewer admissions and raising concerns about the quality of care. The objective of this study was to investigate the early effects of the COVID-19 pandemic on quality of care among stroke and ST-elevation myocardial infarction (STEMI) patients, focusing on clinical outcomes and direct treatment costs. Method: This retrospective, observational study was based on the 10-week period that included the first wave of the COVID-19 pandemic in Israel (15 February 2020-30 April 2020). Emergency department admissions for stroke and STEMI were compared with parallel periods in 2017-2019, focusing on demographics, risk and severity scores, and the effect of clinical outcomes on hospitalization costs. Results: The 634 stroke and 186 STEMI cases comprised 16% and 19% fewer admissions, respectively, compared to 2019. No significant changes were detected in demographics, most disease management parameters, readmission and mortality outcomes. The mean door-to-balloon time increased insignificantly by 33%, lowering the health quality indicator (HQI) for treatment in <90 min from 94.7% in 2017-2019 to 83% in 2020 (P = 0.022). Among suspected stroke patients, 97.2% underwent imaging, with 28% longer median time from admission (P = 0.05). Consequently, only 24.3% met the HQI of imaging in <29 min, compared to 45.5% in 2017-2019 (P < 0.01). Increased length of stay and more intensive care unit admissions were the leading causes of 6.5% increased mean cost of STEMI patients' initial hospitalization, which totaled $29 300 in the COVID-19 period (P = 0.008). Conclusion: The initial pandemic period caused a decline in HQIs linked to diagnostic and treatment protocols, without changes in outcomes, but with increased hospitalization costs. Medical information and awareness of life-threatening conditions among patients and caregivers should be increased to enable proper diagnosis and management.

Original languageEnglish
Article numbermzac074
JournalInternational Journal for Quality in Health Care
Volume34
Issue number4
DOIs
StatePublished - 1 Oct 2022

Keywords

  • COVID-19
  • acute ST-elevation myocardial infarction (STEMI)
  • cerebrovascular accident (CVA)
  • clinical outcomes
  • health quality indicators (HQIs)
  • stroke

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